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Topical polyene antifungals in hematopoietic cell transplant patients: tolerability and efficacy.
Support Care Cancer. 2004 Jul; 12(7):517-25.SC

Abstract

PURPOSE

The effectiveness of amphotericin B oral suspension versus nystatin oral suspension for the prevention of oral colonization by Candida in hematopoietic cell transplant (HCT) patients was examined.

METHODS

Prior to hematopoietic cell infusion, 40 patients receiving systemic fluconazole for prophylaxis were randomized to receive either amphotericin B oral suspension or nystatin oral suspension, q.i.d. The study continued to day 21 or until the patient was discharge from the hospital or withdrawn from the study. Oral examinations were conducted twice weekly, and adverse events and compliance were recorded. Cultures were taken for quantitative counts and species identification. Candida isolates were assessed for resistance to the oral antifungal agents. Blood was collected for assessment of amphotericin B levels.

RESULTS AND DISCUSSION

Ulcerative mucositis occurred in 84.6% of patients undergoing HCT, and no correlation was observed between the severity of mucositis and the presence of oral Candida and the severity of mucositis. Systemic and topical antifungal treatment resulted in a decrease in the number of colonized patients (54.8% before treatment; 23.1% during treatment); however, oral colonization was not eliminated. Tolerability of the oral rinse products was limited, with greater noncompliance in the amphotericin B than the nystatin group. Reports of altered taste appeared to be greater in the amphotericin B group. Minimal absorption of amphotericin B was seen following oral rinsing (serum levels 0.12-0.50 microg/ml), and no consistent changes in organism susceptibility to polyenes were seen. The results suggest that topical antifungal rinses may further control oropharyngeal colonization by Candida in patients on systemic antifungals receiving HCT, but the effect is limited by tolerability and reformulation and should be considered in order to increase compliance.

Authors+Show Affiliations

Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, University of Illinois at Chicago, 801 S. Paulina Street, Room 556, Chicago, IL 60612-7213, USA. jepstein@uic.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Clinical Trial, Phase IV
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15108100

Citation

Epstein, Joel B., et al. "Topical Polyene Antifungals in Hematopoietic Cell Transplant Patients: Tolerability and Efficacy." Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer, vol. 12, no. 7, 2004, pp. 517-25.
Epstein JB, Truelove EL, Hanson-Huggins K, et al. Topical polyene antifungals in hematopoietic cell transplant patients: tolerability and efficacy. Support Care Cancer. 2004;12(7):517-25.
Epstein, J. B., Truelove, E. L., Hanson-Huggins, K., Mancl, L. A., Chen, A., Press, O. W., Petersdorf, S. H., Fritsche, T. R., & Epstein, J. D. (2004). Topical polyene antifungals in hematopoietic cell transplant patients: tolerability and efficacy. Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer, 12(7), 517-25.
Epstein JB, et al. Topical Polyene Antifungals in Hematopoietic Cell Transplant Patients: Tolerability and Efficacy. Support Care Cancer. 2004;12(7):517-25. PubMed PMID: 15108100.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Topical polyene antifungals in hematopoietic cell transplant patients: tolerability and efficacy. AU - Epstein,Joel B, AU - Truelove,Edmond L, AU - Hanson-Huggins,Kimberly, AU - Mancl,Lloyd A, AU - Chen,Alice, AU - Press,Oliver W, AU - Petersdorf,Stephen H, AU - Fritsche,Thomas R, AU - Epstein,Joshua D, Y1 - 2004/04/24/ PY - 2003/09/16/received PY - 2004/03/08/accepted PY - 2004/4/27/pubmed PY - 2004/10/22/medline PY - 2004/4/27/entrez SP - 517 EP - 25 JF - Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer JO - Support Care Cancer VL - 12 IS - 7 N2 - PURPOSE: The effectiveness of amphotericin B oral suspension versus nystatin oral suspension for the prevention of oral colonization by Candida in hematopoietic cell transplant (HCT) patients was examined. METHODS: Prior to hematopoietic cell infusion, 40 patients receiving systemic fluconazole for prophylaxis were randomized to receive either amphotericin B oral suspension or nystatin oral suspension, q.i.d. The study continued to day 21 or until the patient was discharge from the hospital or withdrawn from the study. Oral examinations were conducted twice weekly, and adverse events and compliance were recorded. Cultures were taken for quantitative counts and species identification. Candida isolates were assessed for resistance to the oral antifungal agents. Blood was collected for assessment of amphotericin B levels. RESULTS AND DISCUSSION: Ulcerative mucositis occurred in 84.6% of patients undergoing HCT, and no correlation was observed between the severity of mucositis and the presence of oral Candida and the severity of mucositis. Systemic and topical antifungal treatment resulted in a decrease in the number of colonized patients (54.8% before treatment; 23.1% during treatment); however, oral colonization was not eliminated. Tolerability of the oral rinse products was limited, with greater noncompliance in the amphotericin B than the nystatin group. Reports of altered taste appeared to be greater in the amphotericin B group. Minimal absorption of amphotericin B was seen following oral rinsing (serum levels 0.12-0.50 microg/ml), and no consistent changes in organism susceptibility to polyenes were seen. The results suggest that topical antifungal rinses may further control oropharyngeal colonization by Candida in patients on systemic antifungals receiving HCT, but the effect is limited by tolerability and reformulation and should be considered in order to increase compliance. SN - 0941-4355 UR - https://www.unboundmedicine.com/medline/citation/15108100/Topical_polyene_antifungals_in_hematopoietic_cell_transplant_patients:_tolerability_and_efficacy_ L2 - https://dx.doi.org/10.1007/s00520-004-0634-1 DB - PRIME DP - Unbound Medicine ER -